Prognostic Value of Bone Marrow Tracer Uptake Pattern in Baseline PET Scans in Hodgkin Lymphoma: Results from an International Collaborative Study

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
FIGURE 1.
(A) Example of pure diffuse BM uptake > liver uptake in baseline ¹⁸F-FDG PET (coronal CT slices [a], PET [b] and fused PET/CT [c], and maximum-intensity projection [d]). BMB was negative, and patient was in complete remission (follow-up, +81 mo). (B) Example of multifocal BMI, with 3 focal BM lesions (L2, left ischium, and right scapula) in baseline ¹⁸F-FDG PET, without corresponding CT abnormalities (sagittal slices of CT [a], PET [b] and fused PET/CT [c], maximum-intensity projection [d], axial fused PET/CT [e], and CT slices [f]). BMB was negative, and patient relapsed 6 mo after end of ABVD treatment.
Download figure
Open in new tab
Download powerpoint
FIGURE 2.
Kaplan–Meier PFS curves of different BM ¹⁸F-FDG uptake patterns: no ¹⁸F-FDG uptake, pure diffuse ¹⁸F-FDG uptake > liver, unifocal ¹⁸F-FDG uptake, and multifocal ¹⁸F-FDG uptake. Log-rank P = 0.19.
Download figure
Open in new tab
Download powerpoint
FIGURE 3.
Kaplan–Meier PFS curves of focal PET lesions and nonfocal BM uptake groups (pure dPET⁺ and nPET⁺). Log-rank P = 0.03.

TABLE 1

Clinicopathologic Characteristics and Treatment of the 180 Patients

Characteristic	Total (n = 180)	IVS (n = 133)	Polish study (n = 47)	P
Median age (y)	38.6; range, 19–82.5	39; range, 32.6–48.3	37.7; range, 26–49.8	0.101
Male-to-female ratio	0.8%	0.9%	0.6%	0.515
B symptoms (n)	123 (68.3)	88 (66.2)	35 (74.5)	0.385
Histology				0.275
Scleronodular	142 (78.8)	101 (75.9)	41 (87.2)
Lymphocyte rich	16 (8.8)	15 (11.3)	1 (2.1)
Mixed cellularity	3 (1.6)	2 (1.5)	1 (2.1)
Lymph depletion	13 (7.2)	9 (6.8)	4 (8.5)
Lymph predominance	2 (1.1)	2 (1.5)	0 (0)
Undetermined	4 (2.2)	4 (3)	0 (0)
Ann Arbor stage (n)				0.003
II	62 (34.4)	52 (39.1)	10 (21.3)
III	58 (32.2)	46 (34.6)	12 (25.5)
IV	60 (33.3)	35 (26.3)	25 (53.2)
Mediastinal bulk tumor (n)	78 (43.3)	54 (40.6)	23 (48.9)	0.412
International prognostic score > 2 (n)	55 (30.5)	33 (24.8)	22 (48.9)	0.005
Extranodal involvement (n)	61 (33.9)	40 (30.1)	21 (44.7)	0.101
Radiotherapy (n)^*	68 (37.7)	53 (43.8)	15 (33.3)	0.432

TABLE 2

BM ¹⁸F-FDG Uptake Patterns of the 180 Patients

BM ¹⁸F-FDG uptake characteristic	n	No. of positive BMB
BM ¹⁸F-FDG uptake < liver (nPET)^*	89 (49.4)	5 (2.8)
Focal BM uptake: unifocal (n = 10) and multifocal (n = 28)
Without diffuse BM uptake (pure fPET⁺)	17 (9.4)	4 (2.2)
With diffuse BM uptake (f/dPET⁺)	21 (11.7)	2 (1.1)
Pure diffuse BM uptake (pure dPET⁺)	53 (29.4)	1 (0.6)
Total	180 (100)	12 (6.6)